Cholesterol is a fat (also called a lipid) that your body needs to work properly. Too much bad cholesterol can increase your chance of getting heart disease, stroke, and other problems.
The medical term for high blood cholesterol is lipid disorder, hyperlipidemia, or hypercholesterolemia.
There are many types of cholesterol. The ones talked about most are:
- Total cholesterol - all the cholesterols combined
- High density lipoprotein (HDL) cholesterol - often called "good" cholesterol
- Low density lipoprotein (LDL) cholesterol - often called "bad" cholesterol
For many people, abnormal cholesterol levels are partly due to an unhealthy lifestyle. This often includes eating a diet that is high in fat. Other lifestyle factors are:
- Being overweight
- Lack of exercise
Some health conditions can also lead to abnormal cholesterol, including:
- Kidney disease
- Polycystic ovary syndrome
- Pregnancy and other conditions that increase levels of female hormones
- Underactive thyroid gland
Medicines such as certain birth control pills, diuretics (water pills), beta-blockers, and some medicines used to treat depression may also raise cholesterol levels. Several disorders that are passed down through families lead to abnormal cholesterol and triglyceride levels. They include:
- Familial combined hyperlipidemia
- Familial dysbetalipoproteinemia
- Familial hypercholesterolemia
- Familial hypertriglyceridemia
Smoking does not cause higher cholesterol levels, but it can reduce your HDL (good) cholesterol.
Exams and Tests
A cholesterol test is done to diagnose a lipid disorder. Some guidelines recommend having your first screening cholesterol test at age 20. Everyone should have their first screening test by age 35 in men, and age 45 in women. (Note: Different experts recommend different starting ages.)
It is important to work with your health care provider to set your cholesterol goals. Newer guidelines steer doctors away from targeting specific levels of cholesterol. Instead, it recommends different medicines and doses depending on a person's history and risk factor profile.
General targets are:
- LDL: 70 to 130 mg/dL (lower numbers are better)
- HDL: more than 50 mg/dL (high numbers are better)
- Total cholesterol: less than 200 mg/dL (lower numbers are better)
- Triglycerides: 10 to 150 mg/dL (lower numbers are better)
If your cholesterol results are abnormal, you may also have other tests such as:
- Blood sugar (glucose) test to look for diabetes
- Kidney function tests
- Thyroid function tests to look for an underactive thyroid gland
Steps you can take to improve their cholesterol levels, and help prevent heart disease and a heart attack include:
- Quit smoking. This is the single biggest change you can make to reduce your risk of heart attack and stroke. Eat foods that are naturally low in fat. These include whole grains, fruits, and vegetables.
- Use low-fat toppings, sauces, and dressings.
- Avoid foods that are high in saturated fat.
- Exercise regularly
- Lose weight if you are overweight
Your provider may want you to take medicine for your cholesterol if lifestyle changes do not work. This will depend on:
- Your age
- Whether or not you have heart disease, diabetes, or other blood flow problems
- Whether you smoke or are overweight
- Whether you have high blood pressure or diabetes
You are more likely to need medicine to lower your cholesterol:
- If you have heart disease or diabetes
- If you are at risk for heart disease (even if you do not yet have any heart problems)
Almost everyone else may get health benefits from LDL cholesterol that is lower than 160 mg/dL to 190 mg/dL.
There are several types of drugs to help lower blood cholesterol levels. The drugs work in different ways. Statins are one kind of drug that lowers cholesterol and has been proven to reduce the chance of heart disease.
High cholesterol levels can lead to hardening of the arteries, also called atherosclerosis. This occurs when fat, cholesterol, and other substances build up in the walls of arteries and form hard structures called plaques.
Over time, these plaques can block the arteries and cause heart disease, stroke, and other symptoms or problems throughout the body.
Disorders that are passed down through families often lead to higher cholesterol levels that are harder to control.
Lipid disorders; Hyperlipoproteinemia; Hyperlipidemia; Dyslipidemia; Hypercholesterolemia
Genest J, Libby P. Lipoprotein disorders and cardiovascular disease. In: Mann DL, Zipes DP, Libby P, et al, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 45.
Haney EM, Huffman LH, Bougatsos C, et al. Screening for Lipid Disorders in Children and Adolescents [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007 Jul. Report No.: 07-0598-EF-1 PMID: 20722144 www.ncbi.nlm.nih.gov/pubmed/20722144.
Helfand M, Carson S, eds. Screening for Lipid Disorders in Adults: Selective Update of 2001 US Preventive Services Task Force Review [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Jun. Report No.: 08-05114-EF-1 PMID: 20722146 www.ncbi.nlm.nih.gov/pubmed/20722146.
Semenkovich, CF. Disorders of lipid metabolism. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 206.
Stone NJ, Robinson J, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014 Jun 24;129(25 Suppl 2):S46-8. PMID: 24222016 www.ncbi.nlm.nih.gov/pubmed/24222016.
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Update Date 4/20/2015
Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.